The sensation of pain is a neural-biochemical phenomenon. When acute tissue damage
occurs, neurochemical reactions at the site of injury activate the free nerve endings
of special nerves called nociceptors. Nociceptors initiate an afferent nerve impulse
that propagates through the peripheral nerve, enters the spinal cord, and synapses
with higher order neurons. The impulse then traverses specific ascending spinal tracts,
landing in cerebral centers for interpretation. Modulation of the afferent information
can occur in many areas, including the periphery, spinal cord, midbrain, and cerebral
cortex. Interpretation of the impulse yields a response signal, again traveling through
specific descending spinal tracks and out through peripheral motor nerves. This process
partially accounts for the delay in feeling a sensation of pain after experiencing
an acute injury. Pain sensations can be categorized in many ways, based upon their
speed in traveling in the nervous system (fast and slow pain), the length of time
the pain has continued (acute or chronic pain), or the anatomical etiology of the
sensations (somatic or visceral pain). This article discusses the anatomy and physiology
of pain sensations, concentrating on acute pain mechanisms. Limited discussion is
offered regarding the modulation of pain sensations, and there is a brief overview
of visceral pain. Discussion of chronic pain pathophysiology is included in the article
by Hansen on chronic pain elsewhere in this issue.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribers receive full online access to your subscription and archive of back issues up to and including 2002.
Content published before 2002 is available via pay-per-view purchase only.
Subscribe:
Subscribe to Emergency Medicine ClinicsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Peripheral pain mechanisms and nocciceptor plasticity.in: Loser J.D. Butler S.H. Champion C.R. Bonica's management of pain. 3rd edition. Lippencott Williams and Wilkins, Philadelphia2001: 32-33
- Somatic sensations. II. Pain, headache, and thermal sensations.in: Guyton A.C. Textbook of medical physiology. 8th edition. WB Saunders Company, Philadelphia1991: 520
- Applied physiology of nociception.in: Rowbotham D.J. Macintyre P.E. Clinical Management of Acute Pain. Arnold Publishers, New York2003: 4-14
- The articular polymodal receptor nociceptor in health and disease.in: Kumaza T. The polymodal receptor—gateway to pathological pain. Progress in brain research. vol. 113. Elsevier, Amsterdam1996: 53-81
- Pain.McGraw-Hill, New York1987
- Peripheral neural mechanisms of nociception.in: Wall P.D. Melzack R. Textbook of pain. 3rd edition. Churchill Livingstone, New York1994: 14-19
- The cytoarchitectonic organization of the spinal cord in the cat.J Comp Neurol. 1952; 96: 415-495
- Carpenter's human neuroanatomy.Williams & Wilkins, Baltimore (MD)1996
- Spinal mechanisms and their modulation.in: Loser J.D. Butler S.H. Champion C.R. Bonica's management of pain. 3rd edition. Lippencott Williams and Wilkins, Philadelphia2001: 84-122
- Brain areas involved in nociception and pain.in: Wall P.D. Melzack R. Textbook of Pain. 3rd edition. Churchill Livingstone, New York1994: 113-120
- Is there a pathway in the posterior funiculus that signals visceral pain?.Pain. 1996; 67: 291-305
- Peptides and the primary afferent nociceptor.J Neurosci. 1993; 13: 2273-2286
- Region-specific encoding of sensory and affective components in the human brain: a positron emission tomography correlation analysis.Ann Neurol. 1999; 45: 40-47
- Pain mechanisms: a new theory.Science. 1965; 150: 971-979
- Mechanisms of cutaneous, deep and visceral pain.in: Wall P.D. Melzack R. Textbook of pain. 3rd edition. Churchill Livingstone, New York1994: 129-130
Article info
Identification
Copyright
© 2005 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
